Phase 1
N=46
Crizotinib and Combination Chemotherapy in Treating Younger Patients With Relapsed or Refractory Solid Tumors or Anaplastic Large Cell Lymphoma
Childhood Solid Neoplasm · Recurrent Childhood Anaplastic Large Cell Lymphoma · Recurrent Neuroblastoma
Bottom Line
View on ClinicalTrials.gov: NCT01606878 ↗Enrolled (actual)
46
Serious AEs
54.4%
Results posted
Jan 2024
Primary outcome: Primary: Maximum Tolerated Dose (MTD) of Crizotinib — 215 mg/m^2
Study Design & Population
- Study type
- Interventional
- Phase
- Phase 1
- Interventions
- Crizotinib (Drug); Cyclophosphamide (Drug); Dexrazoxane Hydrochloride (Drug); Doxorubicin Hydrochloride (Drug); Laboratory Biomarker Analysis (Other); Pharmacological Study (Other); Questionnaire Administration (Other); Topotecan Hydrochloride (Drug); Vincristine Sulfate (Drug)
- Age
- Pediatric, Adult · 0+ yrs
- Sex
- All
- Sponsor
- Children's Oncology Group
- Primary completion
- Dec 2018
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Maximum Tolerated Dose (MTD) of Crizotinib |
215 | — |
| PRIMARY Number of Patients With Dose Limiting Toxicity (DLT) |
2; 2; 0; 0; 2; 0 | — |
| PRIMARY Area Under the Concentration |
3792.5; 1549.3; 4070.5; 1612; 3796.6; 7462.8 | — |
| SECONDARY Response Rate |
2; 0; 1; 1; 0; 1 | — |
| SECONDARY ALK Status and Response to Crizotinib |
0; 0; 0; 0; 0; 0 | — |
| SECONDARY MRD Status and Response to Crizotinib |
— | — |
| SECONDARY ALK Expression for Crizotinib |
— | — |
| SECONDARY Acceptability of Crizotinib Capsule Formulation Palatability |
0; 0; 0; 0; 0; 3 | — |
| SECONDARY Acceptability of Crizotinib Microsphere Formulation Palatability |
0; 0; 0; 0; 0; 0 | — |
Summary
This phase I trial studies the side effects and the best dose of crizotinib when given together with combination chemotherapy in treating younger patients with solid tumors or anaplastic large cell lymphoma that has returned or does not respond to treatment. Crizotinib may stop the growth of tumor or cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as cyclophosphamide, topotecan hydrochloride, dexrazoxane hydrochloride, doxorubicin hydrochloride, and vincristine sulfate, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving crizotinib together with combination chemotherapy may be a better treatment for patients with solid tumors or anaplastic large cell lymphoma.
Eligibility Criteria
Inclusion Criteria
- Patients must have had histologic verification of malignancy at original diagnosis or relapse; all patients with relapsed or refractory solid tumors or anaplastic large cell lymphoma (ALCL) are eligible except for patients with primary or metastatic central nervous system (CNS) tumors or patients with primary cutaneous ALCL
- Patients must have either measurable or evaluable disease
- Patients current disease state must be one for which there is no known curative therapy or therapy proven to prolong survival with an acceptable quality of life
- Karnofsky >= 60% for patients > 16 years of age and Lansky >= 50 for patients = = 6 weeks must have elapsed since treatment with therapeutic doses of metaiodobenzylguanidine (MIBG); at least 150 days must have elapsed if prior total body irradiation (TBI), craniospinal XRT or if >= 50% radiation of pelvis; at least 42 days must have elapsed if other substantial bone marrow (BM) radiation
- ALCL: at least 14 days after local palliative XRT (small port); at least 84 days must have elapsed if prior TBI, craniospinal XRT or if >= 50% radiation of pelvis; at least 42 days must have elapsed if other substantial BM radiation
- Stem cell infusion without TBI: no evidence of active graft vs. host disease and at least 84 days must have elapsed after transplant and >= 42 days for autologous stem cell infusion after iodine (I)131-MIBG therapy
- Patients must not have received prior therapy with crizotinib
- Prior anthracycline dose: patients with a total lifetime cumulative anthracycline dose of > 650 mg/m^2 at the time of enrollment are not eligible for Part B of the study
- For patients with solid tumors or ALCL without known bone marrow involvement:
- Peripheral absolute neutrophil count (ANC) >= 1000/mm^3
- Platelet count >= 100, 000/mm^3 (transfusion independent, defined as not receiving platelet transfusions for at least 7 days prior to enrollment)
- Patients with known bone marrow metastatic disease will be eligible for study provided they meet the blood counts (may receive transfusions provided they are not known to be refractory to red cell or platelet transfusions); these patients will not be evaluable for hematologic toxicity; if dose-limiting hematologic toxicity is observed, all subsequent patients enrolled must be evaluable for hematologic toxicity
- Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 ml/min/1.73 m^2 or a serum creatinine based on age/gender as follows:
- Age 1 to = 16 years: 1.7 mg/dL (males) and 1.4 mg/dL (females)
- Bilirubin (sum of conjugated + unconjugated) = = 2 g/dL
- Corrected QT interval (QTc) = = 27% by echocardiogram or ejection fraction of >= 50% by gated radionuclide study
- All patients and/or their parents or legally authorized representatives must sign a written informed consent; assent, when appropriate, will be obtained according to institutional guidelines
- Part C: Patients must have a body surface area (BSA) >= 1.07 m^2 at the time of study enrollment
- Part D: Patients must have a body surface area (BSA) >= 0.43 m^2 at the time of study enrollment
- Tumor tissue must be sent; if tumor tissue is unavailable, the study chair must be notified prior to enrollment
Exclusion Criteria
- Pregnant or breast-feeding women will not be entered on this study; pregnancy tests must be obtained in girls who are post-menarchal; males or females of reproductive potential may not participate unless they have agreed to use an effective contraceptive method during treatment and for 3 months after stopping treatment
- Patients receiving corticosteroids who have not been on a stable or decreasing dose of corticosteroid for at least 7 days prior to enrollment are not eligible
- Patients who are currently receiving another investigational drug are not eligible
- Patients who are currently receiving other anti-cancer agents are not eligible
- Patients who are receiving cyclosporine, tacrolimus or other agents to prevent
Data sourced from ClinicalTrials.gov (NCT01606878). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.